Simulated ward round training in the medical curriculum Munich

Conducting a ward round in a structured and goal-oriented manner is one of the central competencies of a physician's work. Despite its relevance, ward round competence was only addressed in an unstructured way in the Medical Curriculum Munich (MeCuM) prior to 2011. Therefore, the project’s aim was to implement an evidence-based course on medical ward round competence. This project report provides a guideline for developing such a training course. Project planning and development was guided by the steps of the “Kern cycle”, beginning with needs assessment, learning objectives definition, and selection of appropriate teaching methods, and ending with implementation and evaluation.

Mr./Mrs. White (75 years) was admitted to the hospital with a cough and progressive dyspnea. Respiratory symptoms had worsened and the patient was admitted to the hospital as an emergency. Tests ultimately revealed an exacerbation of a newly diagnosed obstructive pulmonary disease. The patient has been in hospital for three days, and clinical symptoms have already improved.
On admission, the chest X-ray revealed a pulmonary nodule in the right upper lobe. Therefore, further radiological diagnostics by computed tomography of the thorax was planned. Role description patient You are Mr./Mrs. White and 75 years old. For several months, you have had this annoying irritating cough. About a week ago, you also noticed shortness of breath. The shortness of breath then worsened and you were admitted to hospital 3 days ago. Actually, you felt very healthy until now. Except for an appendicitis about 20 years ago, you have no previous illnesses. You have been smoking about two packs a day for 30 years.
You have been in the hospital for three days now. The doctors have prescribed two different sprays and several tablets for you to take regularly. In addition, you need to inhale several times a day. You already feel a significant improvement of your breathing problems. The doctors strictly advised you not to smoke, but today you secretly smoked your first cigarette -and you really enjoyed it.
Since your admission, various examinations have been performed, including a lung function and a chest x-ray. This x-ray showed a "nodule in the lung". This morning you went to the radiology department to have a computed tomography scan of the lungs. The examination was very quick -you would have imagined it to be more complicated. The doctors have not seen you yet today, so you will ask for the results of the examination during rounds. Also you had blood drawn this morning, so you'll be interested to know if the signs of inflammation have improved yet -they were "significantly elevated" on the day of admission. When will you be allowed to go home?
Today your wife/husband finally managed to come by. She really wanted to talk to the doctors -you don't really know why... Role description resident Yesterday you had your day off after an exhausting night shift. Today you come back to work on your internal medicine ward. Your colleague has left you a note with the most important information about the patients, as he is on vacation since today.
Mr./Mrs. White had a CT scan and a lung function (for evaluation of the effect of therapy). The patient was admitted to the emergency room 3 days ago for an exacerbation of a chronic obstructive pulmonary disease. The hospitals internal computer system did not contain the results of the computed tomography prior to the ward round. Unfortunately, today you have not been able to visit Mr./Mrs. White yet. You hope that the student has already taken the blood sample and brought it to the lab.

Role description senior physician
You are a senior physician on the internal medicine ward and just arrived for ward rounds. You know Mr./Mrs. White for several days now. He has an exacerbated chronic obstructive lung disease and pulmonary nodule on the chest X-ray. This morning you looked at Mr./Mrs. White's X-ray again and are eagerly awaiting the results of the computer tomography you ordered yesterday. You hope that the CT scan will not confirm your suspicion that the lung nodule is malignant. Tonight, Mr./Mrs. White slept very well. In the morning, the patient went to the radiology department for a CT scan. He just returned to the ward. To the best of your knowledge, the results are still pending.